BCBS is in testing phases right now and if your provider has gotten a postcard from them stating "Congratulations" on the top and goes on to say they are "ready to accept your NPI-only electronic claims", you can go ahead and strip out the BCBS numbers.　 Some providers are being notified by their BCBS Provider Representative when they　have been　approved to submit claims with only the NPI number(s).　 If you are not sure of your status with BCBS, you can find out by calling their E-Commerce Hotline at (800) 746-4614.　

Medicare is also in testing phase.　 If you have been successfully transmitting claims with the Legacy and NPI numbers and are not getting any rejections, you can try sending a claim or two with only the NPI number.　 If these are not rejected, then you are successfully transmitting NPI-only claims and continue to gradually increase the number of claims you send them.

Superior Health Plan has specific requirements which are outlined in the next article of this newsletter.　 Please be sure to follow the instructions there if your practice files claims to them.

To "strip out the numbers" you will go to LISTS > PROVIDER > PROVIDERS. You will need to take the following steps for each provider in this list that you use to send claims.　 Edit the provider file and on the 'DEFAULT PINS' tab, take out the PIN number(s) and UPIN number, leaving all other numbers in tact (i.e. Tax ID#, CLIA#, NPI#, Taxonomy, and Extra fields).　 You will go to the 'DEFAULT GROUP ID's' Tab and take out any group number(s) you might have in the boxes, leaving only the Provider Class box populated if you have an Organizational/Type 2 (aka "group") NPI number.　 Then lastly, you will go to the PINs tab and remove everything: the PIN numbers, Group numbers and any Qualifiers you have attached to the insurance carriers in both columns.　 This last step should also remove the PIN numbers, Group numbers and Qualifiers from the PINS tab in the insurance carrier files for you, so you shouldn't have to go through your insurance carrier list and edit each one to delete them there also. I recommend that you "spot check" them to make sure your version does remove them. You will need to repeat this entire process with your referring provider list also.

SUPERIOR HEALTH　CLAIM REQUIREMENTS

Some of you may have gotten a letter from Superior Health Plan that was dated February 27, 2008 stating that effective May 23, 2008 they have specific requirements for NPI-only claims.　 In the letter it says "All electronic and paper claims must be submitted with an NPI and ZIP+4 of the service location of the billing provider, taxonomy code and tax identification number as outlined below."　 It goes on to list the CMS 1500 and UB-04 requirements listed by field numbers as they appear on each paper form, although they want this information on electronic claims as well.　 Here is the information for populating the fields in Medisoft to meet their requirements.

In the attending, referring and billing provider files, you will need to go to the PINs tab for each and put in the provider's Taxonomy code and a qualifier of ZZ.　 This will take care of boxes 17a (referring provider), 24ja & 24l (attending provider), and 33b (billing provider).　

You need to make sure that you have NPI numbers in the NPI boxes for your attending provider (box 24jb), referring provider (box 17b) and billing provider (box 33a).　 Also, please note the letter states if referring provider information cannot be obtained, they want you to put the attending provider in as the referring provider.　 They will not use it for "claims processing but is required to be filled".

Make sure you are using ZIP+4 in all of your zip code fields, especially in the Practice Information and the Facility files.